In Winters v. Liberty Life Assurance Co. of Boston, 2022 WL 6170588 (D. Mass. 2022), the First Circuit recently denied Liberty’s motion for a judgment on the administrative record on the basis that Liberty had not sufficiently analyzed whether the claimant, Winters, could perform his own occupation.  Winters had been receiving long-term disability (“LTD”) benefits, which Liberty terminated based on its review of the medical evidence and occupational analysis of Winters’ occupation as a mortgage consultant for Wells Fargo.  The court found, inter alia, that Liberty failed to properly investigate Winters’ job duties and apply them to the medical evidence.  The court stated that Liberty’s decision to terminate Winters’ LTD benefits was “unreasonable based on the record before it because Liberty did not complete an assessment of whether Winters was able to carry out all of the material and substantial duties of his own occupation as defined by the relevant disability plan. Rather, Liberty made a determination that Winters could perform sedentary or light physical work.” (Emphasis added).  

Liberty’s position when it terminated Winters’ benefits was that according to the medical evidence, he should be able to perform the duties of his own occupation.  Liberty’s review included independent medical review reports, vocational review reports, and a labor market survey.  However, the court, citing McDonough v. Aetna Life Insurance Co., 783 F.3d 374 (1st Cir. 2015), stated that the relevant question “is not whether Winters is able to perform sedentary or light physical work.  The proper inquiry is whether he is able to perform the Substantial and Material Duties of his Own Occupation – his particular position as a Mortgage Consultant or Financial Services Sales Agent.”  Because Liberty’s vocational review reports and labor market survey focused on the physical demands generally associated with “sedentary” or “light physical” work, rather than on the substantial and material duties of Winters’ own occupation, Liberty had performed only part of the inquiry required of it under ERISA.  

The court distinguished between physical and non-physical duties of Winters’ occupation and concluded that Liberty’s analysis as to whether Winters could perform sedentary or light physical work was only part of the relevant inquiry of whether Winters could perform the material and substantial duties required of a Mortgage Consultant or Financial Services Sales Agent.  Liberty identified non-physical duties of Winters’ occupation in his employer’s job description, but it did not analyze the non-physical duties in the context of the medical evidence, did not include them in its labor market survey, and did not discuss them in the denial letters it sent to Winters.  The court concluded that while Liberty may have properly reached its decision to terminate Winters’ LTD benefits, it was not apparent from the administrative record, as Liberty never made the requisite comparison of the medical evidence against the non-physical duties of Winters’ occupation.  The court stated that “[i]t was insufficient for Liberty to rely on blanket statements from the doctors that restrictions and limitations are not supported by the record without addressing the duties Winters was called upon to perform.”  The court also noted that Liberty was obligated to analyze the medical assessments as compared with the job requirements, rather than in the abstract context of whether Winters could perform “sedentary” or “light physical” work.

In response to Winters’ contention that Liberty should have provided his job description to its reviewing doctors, the court explained that the proper focus of the inquiry was not Winters’ job description or whether he could perform the duties of his particular position at Wells Fargo, but whether he could perform the duties of his own occupation, as defined in the local economy.  While Winters’ job description may accurately describe the duties of his own occupation, Liberty was also permitted to draw on other sources, like the Department of Labor Dictionary of Occupational Titles, to determine the duties of Winters’ own occupation.  

The court ultimately concluded that Liberty did not adequately explain how Winters would be able to perform the duties of his own occupation (particularly the non-physical duties), but rather only analyzed whether Winters could perform sedentary or light work.  Whereas Winters’ job may have been properly described as “sedentary” or “light,” Liberty’s determination that Winters could perform the duties of his job because he had the physical capacity to perform such work failed to take into account other requirements of Winters’ occupation not adequately contemplated by the definition of “sedentary” or “light” work.

The court’s decision makes it clear that insurers like Liberty must apply the medical and vocational evidence to the occupational profile and determine whether a claimant like Winters is disabled.  Liberty’s flaw was that in its analysis, it “improperly conflated Winters’ Own Occupation with general sedentary or light work” (citing McDonough, supra, at 380).  The court went on to explain that while it was possible that Liberty’s decision was sufficiently supported by the medical evidence, it was not evidenced from the administrative record and Liberty did not communicate it properly in its decision letters to Winters.    

The subtle distinction discussed by the court in Winters presents a nuance that is often overlooked.  Therefore, it is critical for a claimant like Winters to retain legal counsel who will know and understand the distinction and how it can impact a given disability claim.  

The attorneys at McKennon Law Group PC are highly experienced in handling ERISA claims, including claims for LTD benefits like in Winters.